PT  - JOURNAL ARTICLE
AU  - Gaurav Garg
AU  - Paul T Finger
AU  - Tero T Kivelä
AU  - E Rand Simpson
AU  - Brenda L Gallie
AU  - Svetlana Saakyan
AU  - Anush G Amiryan
AU  - Vladimir Valskiy
AU  - Kimberly J Chin
AU  - Ekaterina Semenova
AU  - Stefan Seregard
AU  - Maria Filì
AU  - Matthew Wilson
AU  - Barrett Haik
AU  - Josep Maria Caminal
AU  - Jaume Catala-Mora
AU  - Cristina Gutiérrez
AU  - David E Pelayes
AU  - Anibal Martin Folgar
AU  - Martine Johanna Jager
AU  - Mehmet Doğrusöz
AU  - Gregorius P M Luyten
AU  - Arun D Singh
AU  - Shigenobu Suzuki
ED  - ,
TI  - Patients presenting with metastases: stage IV uveal melanoma, an international study
AID  - 10.1136/bjophthalmol-2020-317949
DP  - 2022 Apr 01
TA  - British Journal of Ophthalmology
PG  - 510--517
VI  - 106
IP  - 4
4099  - http://bjo.bmj.com/content/106/4/510.short
4100  - http://bjo.bmj.com/content/106/4/510.full
SO  - Br J Ophthalmol2022 Apr 01; 106
AB  - Objective To analyse ocular and systemic findings of patients presenting with systemic metastasis.Methods and analysis It is an international, multicentre, internet-enabled, registry-based retrospective data analysis. Patients were diagnosed between 2001 and 2011. Data included: primary tumour dimensions, extrascleral extension, ciliary body involvement, American Joint Committee on Cancer (AJCC)-tumour, node, metastasis staging, characteristics of metastases.Results Of 3610 patients with uveal melanoma, 69 (1.9%; 95% CI 1.5 to 2.4) presented with clinical metastasis (stage IV). These melanomas originated in the iris, ciliary body and choroid in 4%, 16% and 80% of eyes, respectively. Using eighth edition AJCC, 8 (11%), 20 (29%), 24 (35%), and 17 (25%) belonged to AJCC T-categories T1–T4. Risk of synchronous metastases increased from 0.7% (T1) to 1.5% (T2), 2.6% (T3) and 7.9% (T4). Regional lymph node metastases (N1a) were detected in 9 (13%) patients of whom 6 (67%) had extrascleral extension. Stage of systemic metastases (known for 40 (59%) stage IV patients) revealed 14 (35%), 25 (63%) and 1 (2%) had small (M1a), medium-sized (M1b) and large-sized (M1c) metastases, respectively. Location of metastases in stage IV patients were liver (91%), lung (16%), bone (9%), brain (6%), subcutaneous tissue (4%) and others (5%). Multiple sites of metastases were noted in 24%. Compared with the 98.1% of patients who did not present with metastases, those with synchronous metastases had larger intraocular tumours, more frequent extrascleral extension, ciliary body involvement and thus a higher AJCC T-category.Conclusions Though higher AJCC T-stage was associated with risk for metastases at diagnosis, even small T1 tumours were stage IV at initial presentation. The liver was the most common site of metastases; however, frequent multiorgan involvement supports initial whole-body staging.Data are available upon reasonable request. All data relevant to the study are included in the article or uploaded as supplementary information. All data relevant to the study are included in the article or uploaded as supplementary information. Data are available upon reasonable request.